Archived: Ambuline Chesterfield

Ambuline Chesterfield is operated by Ambuline Limited, which is a subsidiary of Arriva Transport Solutions Ltd.

Ambuline Chesterfield provides a non-emergency patient transport service (PTS) in North Derbyshire. They have a 'control desk’, which operates from the NHS hospital’s outpatients department. The service has a base approximately two miles from the hospital where the vehicles are stored and crews start their shifts. The service operates to transport patients to and from neighbouring NHS hospital outpatient departments, and to and from the patients’ home address.

We inspected patient transport services (PTS) using our comprehensive inspection methodology, in March 2017 which resulted in enforcement being taken against the provider for two regulations of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. These were:

• Regulation 13 Safeguarding service users from abuse and improper treatment

• Regulation 17 Good governance

The full report of this inspection can be found on the CQC website: https://www.cqc.org.uk/location/1-202455260                                                            

As a result of our findings we issued a warning notice served under Section 29 of the Health and Social Care Act 2008 in June 2017. In order to follow up on progress against this warning notice we carried out a short notice announced focused inspection on 5 October 2017.

At this inspection we visited the control desk, which was located at the NHS hospital and the service’s ambulance station at Chesterfield. We spoke with 10 members of staff including managers, control staff and PTS drivers.

As this inspection was a focused inspection, we looked at the safe and well-led domains only.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the provider had met the requirements of the warning notice but there were still some areas that required further improvement:

• The supervisors, control patient transport drivers had not had updated adult and children’s safeguarding level two training as recommended in national guidance.

• Staff were not consistent in their knowledge of how to recognise or report a safeguarding concern in order to protect people from avoidable harm and abuse.

• Information was not provided in all ambulance vehicles to assist in making safeguarding referrals.

• Ambulance staff had no computer access to current policies stored on the web based portal.

However we also found the following areas of good practice:

• Senior managers and supervisors had undertaken incident management training and were able to identify, investigate and review themes in order to fully address incidents within specific timelines.

• A 24 hour, seven day a week incident reporting telephone number had been provided to all staff.

• A quality bulletin was available for all staff to read highlighting incidents and learning points identified.

• Management staff had received updated training in line with safeguarding level three as recommended inNational guidance from the Intercollegiate Document for Healthcare Staff (2016)

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected patient transport services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central), on behalf of the Chief Inspector of Hospitals

Ambuline Chesterfield is operated by Ambuline Limited, which is a subsidiary of Arriva Transport Solutions Ltd. Ambuline Chesterfield provides a non-emergency patient transport service (PTS) in North Derbyshire. They have a 'control desk’, which operates from the NHS hospital’s outpatients department. The service has a base approximately two miles from the hospital where the vehicles are stored and crews start their shifts. The service operates to transport patients to and from neighbouring NHS hospital outpatient departments, and to and from the patients’ home address.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection between 13 and 15 March 2017, along with an unannounced visit on 27 March 2017.

We visited the control desk, which was located at the NHS hospital and the service’s ambulance station at Chesterfield. We inspected these locations in order to speak to patients and staff about the ambulance service.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• We were not assured that there were reliable systems, processes and practices in place to safeguard adults, children and young people from avoidable harm.

• Staff told us that it was difficult to report incidents, as they did not have direct access to the electronic incident reporting system. Staff were not able to give examples of when lessons were learned when incidents occurred or things went wrong.

• The lead for safeguarding did not have regular contact with all of the social care safeguarding leads for the locations in which they provided care to the public.

• Infection prevention and control processes were in place however the cleaning of vehicles was not visibly cleaned to a consistent standard. Staff did not have time allocated within their working hours and vehicles were cleaned in their own time.

• Staff we spoke with could not describe the meaning of the process concerning duty of candour. This is a regulatory duty that requires providers of health and social care services to disclose details to patients (or other relevant persons) of ‘notifiable safety incidents’ as defined in the regulation. This includes giving them details of the enquiries made, as well as offering an apology.

• Staff received annual mandatory training however; the majority of staff we spoke with did not feel that the training provided them with all of the skills and knowledge required for their role.

• Records were stored in a filing cabinet, which was locked however; the cabinet could potentially be accessible to the public when control staff were off duty.

• Road staff did not make operational decisions in relation to faults on a vehicle check. However, they were sometimes told to take the vehicle on the road despite a fault being identified, which caused conflict and disagreements.

• All staff we spoke with did not have supervised observational practice sessions with their manager.

• The service had not completed staff appraisals to meet the service target.

• The service had a strategy and vision. However all of the staff we spoke with were not able to articulate the vision and strategy of the organisation.

• The service had a governance process however this was not managed effectively and frontline staff were not involved with the process.

• Staff were committed to improve the service but felt unable to do so.

• The leadership team were not visible and staff did not feel able to approach them to discuss their concerns.

• There was a concern that a blame culture existed when accidents or incidents were reported.

• Local team meetings did not have action plan trackers to ensure actions were implemented.

However, we found the following areas of good practice:

• Policies for care and treatment reflected relevant research and guidance.
• Patients were assessed using national evidence based guidance.
• Staff, teams and services worked together effectively to deliver effective care and treatment.
• Response times were good and feedback from service users confirmed this.
• The service monitored their performance and was the highest performing service in the region.
• Hospitals receiving patients from the service told us that they had effective handovers from staff.
• Patient’s consent to care and treatment was obtained in line with legislation and guidance.
• Staff positively interacted with patients; we observed staff communicating effectively with patients.
• Staff treated patients with kindness, compassion, dignity and respect at all times.
• Staff responded compassionately when patients needed help and supported patients emotionally. This was reflected in patient feedback and their care and treatment.
• Feedback from patients was unanimously positive about the care and treatment they had received.
• Staff took the needs of different patients into account when providing transport services.
• There was a shared understanding between staff that every patient had individual needs.
• Services were planned and delivered in a way, which met the needs of the local population.
• There was a system to support staff to communicate with non-English speaking patients.
• Complaints were investigated in accordance with the service’s policy.
• Staff we spoke with were extremely proud of the care the frontline staff gave to the patients in their care.
• Staff were very positive about their local line manager who was visible and staff could approach the manager with any concerns they had.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with four requirement notices and a warning notice that affected patient transport services. Details are at the end of the report.

Importantly, the provider must take action to ensure compliance with regulations 15 13, 17, 18 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Heidi Smoult

Deputy Chief Inspector of Hospitals